title: Long-term clinical outcomes of patients with unprotected left main bifurcation lesions treated with 2-stent techniques.
abstract: BACKGROUND
  Currently available evidence suggests that outcomes are less favorable when left main (LM) bifurcation lesions are treated with 2-stent techniques compared with a single-stent technique. We aimed to evaluate the long-term outcomes of the 2-stent techniques for treating unprotected LM bifurcation lesions in Chinese patients.
  
  
  METHODS
  We enrolled 301 consecutive patients treated with drug-eluting stents (DES) implantation using 2-stent techniques for unprotected LM bifurcation lesions (MEDINA 1, 1, 1, 70.5%). The 2-stent techniques included crush technique, V stenting, T stenting, and Culottes stenting. After stenting, both vessels were redilated at a high pressure before final kissing balloon (FKB). Clinical and angiographic data were analyzed. The primary endpoints were major adverse cardiac events (MACE), which included death, myocardial infarction, and target lesion revascularization.
  
  
  RESULTS
  Immediate procedural success was obtained in all cases with a FKB success rate of 95.3%. Follow-up data were available for all patients. The overall incidence of angiographic in-stent restenosis (ISR) rate was 20.3% and most ISRs were of the focal type. During long-term follow-up (mean duration, (54 ± 22) months), the cumulative incidence of MACE was 11.0%, with 8 (2.7%) deaths, 7 (2.3%) myocardial infarctions, and 18 (6.0%) repeated lesion revascularization. MACEs in high SYNTAX score terciles were significantly higher compared with those in low and intermediate SYNTAX score terciles (P = 0.001).
  
  
  CONCLUSIONS
  Although percutaneous coronary intervention (PCI) with 2-stent technique for unprotected LM bifurcation lesions was accompanied with a slightly high incidence of ISR, the long-term clinical follow-up is acceptable. Technical modifications and stent innovations may further improve both the angiographic and clinical outcomes for patients with LM bifurcation disease treated by PCI.
authors.affiliation: Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
authors.forename: Han-jun
authors.initials: HJ
authors.lastname: Pei
authors.forename: Yong-gang
authors.initials: YG
authors.lastname: Sui
authors.forename: Yong-jian
authors.initials: YJ
authors.lastname: Wu
authors.forename: Yue-jin
authors.initials: YJ
authors.lastname: Yang
authors.forename: Bo
authors.initials: B
authors.lastname: Xu
authors.forename: Ji-lin
authors.initials: JL
authors.lastname: Chen
authors.forename: Shu-bin
authors.initials: SB
authors.lastname: Qiao
authors.forename: Jian-jun
authors.initials: JJ
authors.lastname: Li
authors.forename: Xue-wen
authors.initials: XW
authors.lastname: Qin
authors.forename: Min
authors.initials: M
authors.lastname: Yao
authors.forename: Jin-qing
authors.initials: JQ
authors.lastname: Yuan
authors.forename: Jue
authors.initials: J
authors.lastname: Chen
authors.forename: Hai-bo
authors.initials: HB
authors.lastname: Liu
authors.forename: Shi-jie
authors.initials: SJ
authors.lastname: You
authors.forename: Run-lin
authors.initials: RL
authors.lastname: Gao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000453:epidemiology; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome